Differentiation of ventricular septal defects from mitral regurgitation by pulsed Doppler echocardiography.

Forty youngsters with apical systolic murmurs, whose clinical evaluations did not allow conclusive differentiation between ventricular septal defect (VSD) and mitral regurgitation (MR), were studied by pulsed Doppler echocardiography (PDE). The PDE technique, which supplements M-mode echocardiography with Doppler flow detection, allowed determination of the site of turbulent blood flow in 39 of the 40 youngsters (97.5%percnt;). Twenty-one had PDE findings of VSD but no MR, and the 10 who underwent cardiac catheterization had VSD demonstrated. Seventeen youngsters had PDE findings of MR but no VSD, and the six who underwent catheterization were found to have MR, and no VSD. One youngster had both VSD and MR demonstrated by PDE and catheterization, and one had no abnormalities detected by either PDE or invasive study. The sensitivity and specificity of PDE for determining the origin of troublesome apical murmurs has obvious clinical utility.